here for student ambassador national counsel of youth safety and a senior at bethesda high school in maryland. i sustained a serious head injuries which we later discovered was my third concussion. until then i did not appreciate what a great life i was living. i got good grades in challenging classes, played high school lacrosse, walk working on my second degree black belt in martial arts, had a job i loved teaching tae kwon do, performed in jazz ensemble and had an active social life. it was over in a split second. my concussion left me with only 5% of cognitive activity and i was almost immobilized. two and a half years i spent recovering and at times have wondered if i would ever get that life back. it has been a long, slow process. at first all i wanted to do was sleep. noise, light, even moving my eyes caused headaches and

nausea. i was enrolled in the children's hospital score program that dr. goia will describe later where i received ongoing cognitive evaluation and treatment for symptoms. after missing school for two weeks, i tried to go back but was unable to function. the frustration of trying to focus on lectures, moving through the pandemonium of the halls and constant sensory bombardment made a normal school day impossible. however, through my school i eventually enrolled in a home teaching program. with the help of tutors and family, was able to complete my coursework at my pace. i returned in september but was far from recovered. i have spent two and a half years since my concussion slowly regaining organizational skills, the ability to learn and retain information, and most important my personality. during this time, my friends and family learned to recognize the signs that meant i needed to shut down from any mental or

physical activity for a day or two. these relapses were particularly tough and discouraging and meant i had to drop a class, miss a band trip to chicago, among other things. the worst was when i had a crash and could not go to my first concert, the red hot chili peppers. the friend i gave my ticket to really owes me. the spring after my injury, i was medically cleared to return to sports but made the hard decision i would not play lacrosse or other intensive sports again. i know that a lot of people recover and return to play, but the possibility of another concussion means i could lose everything again just like that and not come back the next time. i now look at my recovery as something that has made me stronger but i know that i'm one of the very lucky ones that had the resources and medical attention i needed and a school system that is aware of concussion issues and provided an unusually high level of support. it is not over yet. my recovery continues. but my outlook is positive and

i'm excited about the future as i prepare for college. i'm thinking about becoming a high school math or science teacher. i now have a hard question. what can be done to create a safer sports environment and ensure when injuries do occur, the support for full recovery is available. we can't do away with youth sports. i played baseball, travel soccer and league and high school lacrosse. being on those teams not om gave me a healthy outlet but taught me important lessons. sports are one of the best parts of growing up and becoming a strong adult. they teach us that if we work hard, we'll become skilled and proud of our accomplishments. they teach us how to be part of a team, have pride and success and learn the lessons of defeat. they teach us sometimes we have to quit thinking of ourselves and think of the good of the team. for these and many other reasons, i hope that steps can be taken so that future young athletes have these

opportunities. there are two important things i think would make a big difference. the first is to change the cultures of hitting hard to take out a good opponent rather than playing to win through skill and brushing off injuries to get back into the game. while better equipment may decrease injuries, it is coaches, parents and players who have a too back away from the need to win at all costs, or fear the losing status on the team to be out for an injury to be willing to recover fully before returning to play. it will take a while. if youth and professional sports are to survive, these attitudes must be embraced. second, when injuries do occur, we must have a way for qualified personnel to quickly assess injuries on the field, have players get immediate attention, and then support recovery through schools and medical institutions. these are the things that were done for me and are the reason i've been able to return to normal. as a student ambassador for

ncyss, the message i hope to give young athletes are this. you think you're invulnerable. you take risks and brush off injuries because you think you will recover quickly from anything that happens. you won't. don't be a hero, especially when it comes to your head. it's the only brain you'll have, and your personality is who you are. it's not worth a couple of seasons of glory to lose the opportunity of a lifetime. thank you. >> very good. dr. graham, you are recognized for five minutes. >> thank you very much. chairman terry, ranking member. my name is bob graham. i served as chair of institute of sports related medicine and youth study. as you have my testimony before you and i think copies of the study itself, i will just try to take these minutes to give you a summary. the institute of med sip part of the national academy of science

chartered to provide advice on very scientific issues. we were specifically empaneled to look at the evidence about the causes and consequences of concussion in youth and military state of diagnosis management, role of sports equipment and regulation. we have 17 members on our committee. we work in 2013. dr. molfese, who will follow me, was a member of that committee. we came with just six recommendations. the first was that the cdc needed to establish a better mechanism for national surveillance to comprehensively capture incidents of concussions. you've heard a number of figures about the concan you gos in one sport or another. we know what the incidence is when they are measured. we do not know where they are

not measured or more closely watched. we need to have that spas libaso know and as we take corrective measures, the success we're having on decreasing the incidence of concussion. number one, better epidemiology. number two, couple of recommendations related to research. we need nih and dod to look more what metrics and markers are for concussions. how do you assess the severity of a concussion. how do you find diagnostically whether or not an individual has had a concussion. right now it's largely based on observation and self-report. are there physiologic markers used to give us better documentation when the concussion has actually occurred

perhaps without the individual knowing it or it being observed. secondly we need nih and dod to look at more carefully longitudinally at the short and long-term consequences of discussions. we heard testimony in this panel, prior panel, individuals who had one or more concussions. long-term sequela. that gives us a sense about not only, again, epidemiology of the problem we're dealing with but what treatments may be and what rehabilitation may be. fourth recommendation to the ncaa and national federation of state and high school associations to look at age appropriate tech niece and roles and playing standards. again, first panel talked a little about that, mostly at professional level. change the manner the sport is practiced and the rules of

engagement in the sport that may decrease risk of concussion. one example of hockey area where they changed the level where they allowed body-checking and felt they saw a decrease in concan you go. we think that same sort of examination should take place at the college and elementary and high school level to see whether or not they can have the same impact. the fifth recommendation had to do with a better study of what the role may be for protective equipment. the first panel talked a lot about that. committee had a number of questions about that. our committee found very little evidence that helmets protect against concussions. a lot of data in that. some of the other panelists talk about that. may come away with equivalence degree in physics this morning.

complicated issue. there are a number of suggestion. we certainly don't recommend you not use helmets. they do protect against bone injury and soft-tissue injury, but the suggestion that a helmet itself may decrease the incidence of concussion, the evidence does not appear to be there to us. we think that the n itch h and dod again have a role looking more specifically at what -- changing the culture and the way concussions are viewed. this is a significant injury. athletes need to be encouraged to report, take themselves out of the game. coaches and parents need to be encouraged to say for your own protection you need to be removed and give yourself a chance for recovery. thank you very much.

>> thank you, doctor, you're recognized for five minutes. >> thank you, mr. chairman, chairman and members of the subcommittee for this opportunity. if we could have the slides. so group talked about the number f of -- if you can go ahead and put that on power point. a number of sports where rate of concussion is high. there are, of course, differences in rates for men and women. dr. gay will talk about some of that in terms of weaknesses of women's next relative to men's next now. that puts them perhaps at risk of concussion. next slide. concussion accounts for in the united states roughly about 75%

of traumatic brain injuries. it is a brain injury. there is damage to the brain. there's a discussion about whether it's permanent or temporary. in the military the rate is 77%. so turns out that youth sports ar good model for also looking at concussion in terms of the military. in fact, most of the military concussions occur in situations most like they do with the rest of america. some certainly occur in theater, but the majority occur outside of theater, accidents prone to experience. next slide. >> if we look at brain injuries overall, estimates -- these are all estimates, of course, and they vary across the literature. we're looking at somewhere probably in the neighborhood of 4 million traumatic brain injuries in the united states. a sobering part of that is our birth rate in the united states is also about 4 million.

this does not account other ways children are exposed to head injuries. perhaps a disciplining irate parent that slaps a child that creates rotational movement can, in fact, produce a concussion. those, we expect, are unreported. recovery is pretty quick. anywhere from a few hours to a few days. some will persist two weeks even out to six weeks, but roughly about 20% seem to persist beyond that time. next slide, please. this is a slide on some data under review. it will give you a sense, these are data using brain electrical activity. a net of 256 electrodes that fits on the head in about 10 seconds or so. we present in this case a series of numbers. one number at a time.

all the college athletes had to do was simply say whether the number they currently see matches or does not match a number that occurred two positions earlier. and on the left side those orbits, circles you see, colored circles, on the left for match and nonmatch, these are images of the brain electrical activity on the scalp recorded from those electrodes between 200 and 400 millisecon milliseconds. .2 for .4 of a second after the number appears. the schematic on the right shows you the head position. a very rapid brain response. for those athletes who have no history of concussion, we see no difference in the electrical activity for match versus mismatch. we see red, various shades of blue from the front of the head to the back of the head. on the right, though, these are

individuals with a concussion history of one to two years earlier, not current. yet at 204 milliseconds, the brain cannot discriminate whether those two numbers are the same or different. they also might get these tasks correct but takes them roughly 200 milliseconds longer, 200 synapses. processing speed is low. after two years one might suspect that's a permanent change. next slide. yeah. so in terms of critical scientific gaps, some of these we do, dr. graham talked about. how does concussion affect the brain in the short and long-term. we really don't have much information about that. what's the dose requirement. dr. graham talked about that. to produce concussion, postconcussion syndrome. how can we reliably objectively

know when the brain is injured and more importantly, fully recovered. we have no ways to do it. lots of individual differences from one person to the next. we think there are genetic factors involved but also a concussion history the person may not think they have. how many of us have bumped our head getting in and out of the car. we have a quick rotational movement and that could produce, perhaps, a concussion. how does the brain recover from tbi and finally how we improve and recover, accelerate recovery. we really have no scientific basis for any interventions. thank you. >> thank you, d. dr. johnston you're recognized for five minutes. >> thank you for inviting me to testify alongside this illustrious panel about our experience. >> pull the microphone better?

>> is that better? following passage of concussion legislation as well as work we're currently doing at the university of alabama birmingham to improve safety. as in nebraska youth sports and football are an important part of our culture. as a result we take the safety of our children seniorsly as well. it's gained prominence over the past decade thanks to research and advocacy work by scientists, physicians, public health centers across the united states, work of public officials highlighting research. significant concern recent studies identified potential long-term health consequences depression, encephalopathy and other neurologic diseases associated with impacts. professional football gets media attention, it's important to keep in mind over 70% of all football players in the u.s. are under 14 years of age. any effort directed at safety in football will need to address these youth athletes. parallel to enacting alabama's

concussion law as in alabama as in many states alabama task force, think first alabama initiated staytewide concussion awareness program and it worked. in the first year we found 500% increase in referral of youth athletes referred to the clinic at children's of alabama, a trend that held steady since that time with 350 youth athletes seen every year. to optimize care of this rapidly increasing patient population, we developed a protocol. following guidelines, athletes were evaluated by physicians expertise in concussion, kept out of school until symptom-free, referred for testing if necessary, supervised return to play or program. a formal study in 2012 demonstrated establishing this program ruled in significantly better concussion care and resources utilization. even though these efforts, treatment of concussion in

alabama and other states much needs to be done to prevent sports related injury in the first place. the difficulty of a concussion threshold as has been said previously, using subjective ways of evaluating athletes, research widened focus from concussion to correlative cumulative over time advanced mri images and in your lodge. animal models have problems with cognitive impairment, spatial learning. as seen also in football players compared to single impact controls in those that have not had injuries definitive threshold impact frequency hit counts cannot be drawn from these early studies it has being clear sub concussive kbax, those that don't result in concussion play a role in cumulative over time need to be studied. wake forest suggest a

significant portion of young players head impact actually takes place during practices. the largest impacts happen to take place during those practices a lot of times doing outdated drills, oklahoma drill or bull in the ring supervised by well meaning but untrained coaches. emulating top level collegiate programs who don't do these practices and drills, teams like university of alabama, ivy league and others alabama high school athletic published nonbinding guidelines to limit full contact hitting practices to twice per week. i believe this type of intervention is complimentary to stuff usa football talking about tech neegs, not just techniques but the number of hitting practices per week as well as what drills are going to be done during practice. pop warner instituted similar guidelines but a small section. frequency of hitting at practice as well as type of drills would have large effect on safety decreasing cumulative impact exposure for every youth football player in america. also become clear football

helmet standards defined by national committee for athletic commitment must be updated to reflect our understanding of ideologies, impact and acceleration play a role in concussive physiology only linear impact studied, from a skull fracture tolerance model developed in the 1960s. we believe having multiple other -- complete impact necessary in the field to come up with meaningful standards, in connection with the football program, uab, previously university of nebraska develop a safer barrier have develop a robust analysis system to analyze impacts and recreate them in a purpose built lab. in conclusion the passage of concussion awareness legislation, community education, recent advances head impact exposure in youth athletes improved overall safety of impact sports and recognizing

concussions more frequently. however much work specifically in education and drafting policies to limit head impact exposure for youth athletes in contact sports. as part of this multifaceted approach to complex problem new helmet standards is crucial for doemt of helmets. mr. chairman, thank you for the opportunity to testify. >> thank you. dr. gay, you are recognized for five minutes. >> thank you, chairman terry. i'd like to thank the subcomputer for inviting me to testify today. i'm speaking to you as a football fan who happens to be a physicist. my main professional interest is how equipment works and how it can be improved. today i wish to consider several aspects of football problematic as far as concussions go and how we might move forward to make the game safer. american football is an inherently violent sport. that's one of the reasons we love it. forces in football can be huge.

consider a big hit between a running back and linebacker at full speed. we can show using newton's law the force they exert on each other is three-quarter of a ton. that's why football is called a contact sport. two players who collide at full speed helmet to helmet are experiencing same force one would feel if he had a 16 pound bowling ball dropped on his helmet from a height of 8 feet. medical knowledge of concussions is in its infancy. we know one thing for sure. forces to the head and neck cause concussions. we've just heard how big these forces can be. here is another problem. they are getting bigger. since 1920, the average way to pro alignment has increased 60% to just over 300 pounds. at the same time these players have gotten about 10% faster. providing speed and mass to calculate kinetic injury, available to cause injury, we find the amount of injury dumped

into the pit at the line of scrimmage on any given play has almost doubled since 1920. an exact opposition to this friend is the fact that players are shedding their protective gear. fine knee pads that used to be centimeters thick now bear a remarkable resemblance to tea cup doilies. popular alignment of my generation have gone the way of the flying wedge. modern football helmets are tlg cal marvels but players choose them not for their cushioning ability but how cool they look. another problem is state of medical knowledge. while i'm not competent to explain, i think it's safe to say a room full of head trauma physicians won't agree on what the details are and what causes them. this means treatment has a long way to go. as understanding improves, we may find injury rates due to the increasing energy of the game and wholesale shedding of

equipment has increased faster than we thought. finally, football is big business especially at the college and professional levels. when forces manifest themselves as they do, for example, bounty programs and illegal doping to improve performance, the game becomes more dangerous. what are the solutions? we need better equipment. more energy to the helmet will lower the force delivered to a player's skull. this has been tried in the past. the problem is the added padding increases increase diameter as well as co-efficient of friction opposing player can have more torque on the head. nonetheless several companies basic same padding for youth football youth players collisions to the head certainly greater. use of the star system for rating helmets and hit system

for monitoring collision toss a players' head represent important first steps toward improving football safety. physiological epidemiological conclusions related must be improved. there is now an understanding in the nfl and at the college level that significant research in the area is needed. several of the members of this panel including my colleague from nebraska dr. molfese leading in this area. finally incremental rule changes and enforcement of existing rules are needed. rules targeting, peel back blocking and defenseless opponent are making players more hesitant on the field. these rules may actually increase the rick of injury. rule changes should be studied and possibly reversed.

it is my belief that return to a level of padding worn in 1970s make the game significantly safer. more thorough doping rules should be developed and actually enforced. nfl season should be reduced to 14 games and college season returned to 11. finally more stringent requirements regarding when a player with a concussion can return to the game need to be implemented. these are my thoughts for your consideration. thank you for your attention and your valuable time. >> thank you for your valuable time. and dr. goia, i appreciate you being here. you are recognized for five minutes. >> thank you, chairman terry, ranking member and members of the subcommittee. i appreciate the opportunity to speak on behalf of the safety of our children in this country. i'm a pediatric neuropsychology at children's national health in washington, d.c. and director of the score concussion program. i'm a clinician, researcher and

public health educator. today i'd like to take my time to focus my comments on the importance of public health education for youth concussion using my expertise as a clinician and researcher. i've worked for the last decade with cdc on their heads up concussion program materials. we all know, i think ian said it just perfectly, that sports and recreation provide important developmental opportunities to enrich the lives of our youth. they teach life lessons. we have to balance those incredible benefits of sports participation with careful attention to safety issues and science must drive our action oriented approach. concussions are serious injuries to the brain that threaten the development of our youth. in an attempt to protect our youth, we now have laws in all 50 states and the district of columbia, all with the good intent of protecting student athletes for rules educating coaches and parents and removing

suspected concussions and now allowing them to return until properly clear. all states, include the high school at this level but only 15 out of those 51 include youth sports. less than one-third are looking at the majority of athletes. in preparing for this testimony, i was posed with an important question and challenge within youth sports. with concussion awareness at an all-time high, our youth sports teams and organizations and parents more aware but till not sure what to do about it. the simple answer to that question, with my experience, is yes. many coaches and parents are not equipped to know what to do with a suspected concussion. mechanisms to teach active recognition and response to every coach and parent are inconsistent and limited in scope. the health and safety of youth athletes is in the hands of coaches and parent at the youth level. they need medically guided

training in early identification of concussion and protection. coaches and parents must receive training in action oriented concussion response. awareness isn't enough. they have to be prepared properly. we know that as you've heard, repeated concussions present the greatest challenge to our youth. our greatest challenge is the universal, consistent and effective implementation of these 51 laws so that we can prepare those coaches an parents to know what to do and have the tools with which to do it. at children's national health system over the past ten years our score program delivered hundreds upon hundreds of action oriented parent and coach concussion educated train program using materials from cdc. we've learned much about community needs. we've training where we present to coaches and parents an actual situation and what they must do

and recognize and respond. this is all very, very important as we put these responsible adults in place. you've heard about some important other kinds of activities and good examples of head safe action, head smart action, such as usa football's heads up tackling program where coaches are educated in concussion recognition response but also taught techniques that we believe can improve taking the head out of the game. but we have to go further in all youth sports. we do not have a coordinated universal strategy at this point for action oriented solution driven methods to recognize and respond to these injuries. we have the tools, we have many of the programs, but we do not at this point have the delivery mechanism to do that. so we have to build also on active partnerships between youth sports organizations and medical care systems. concussions are complicated. they are not simple. we're not asking parents and

coaches to be clinicians and go out and diagnose. willing teammates you've heard through usa football, lacrosse, rugby and other organizations but we need to build those partnerships. we need the help of the professional sports leagues as you're hearing from nhl and nfl and sports manufacturing world to team with us. we also need a quarterback ultimately to make this happen. we have to leverage the efforts of other organizations like the national council on youth sport safety, youth sport safety alliance, sarah jane plan, all of this is important for us to do. we need obviously funding to do that to move forward. can we move from awareness to action? yes, we k concussions are serious injuries that threaten our youth, but we do not need to be scared away from that. we do not need to avoid developmentally appropriate participation in sports activities. what we need to do is focus on how to teach recognition and

response and our country needs a good, universal mechanism to implement community focus youth concussion solutions. we believe that can help children ultimately as they enjoy benefits of sports. our score model applies here. it says play hard, play safe, but play smart. thank you. >> very good. doctor, you are now recognized for your five minutes. >> thank you. i want to thank chairman terry, ranking member schakowsky, members of the subcommittee i'm honored to be here today. my focus on radiological evidence of concussion and sub concussive blows to the head. if i can have the next slide. what is known mild traumatic brain injury is common in sports injury. when we're talking about a single mild tbi, about 80% get

better, between 15 and 30% go on to have persistent concussive symptoms as have been described today. what's most concerning chronic traumatic encephalopathy and other nerve degenerative disorders. that's the second one where it's repetitive mild traumatic brain injury that we're really concerned w the clearest evidence comes from postmortem studies. if i can have the next slide this is a study that shows protein in the brain. this is a case of a retired professional football player who had symptoms and presumed to have chronic traumatic encephalopathy which was confirmed postmortem. next slide, please. here are four individuals, a, b, c, d. what's interesting, this is work by gold steam, blast injury and repetitive brain trauma look the

same at postmortem. we have a military person 45 one close range blast injury, 34-year-old with two blast injuries, an amateur football player at the age of 18 with repetitive concussions and 21-year-old with subconcussive blows to the head only. next slide, please. what is known? we've gone over the first two. third is mild tbi is difficult to diagnose. that's been a serious problem. if you use conventional ct and conventional mri, you're not likely to find differences or abnormalities in the brain. many people have said there's no problem then. the problem is correcten tools have not been used until more recently. now with advanced neuroimaging we're able to diagnose and move towards progress nose and hopefully intervention. advanced neuroimaging diffusion imaging we've been using in our laboratory show radiological

evidence of brain alt reagans in living individuals with mild tbi. so we can detect this early and perhaps then look at underlying mechanisms and characterize what's going on in order to come up with preventive measures. next slide please. this is a study looking at university players. first preseason and postseason. red dots are three individuals who had concussions from preseason to postseason. the increase is increase in extra cellular water in the brain, which is not a good sign. next slide, please. we also looked at gray matter, looking at cortical thinning, this is a study of former professional football players who were symptomatic when we looked at them. what we found is there's

cortical thinning compared to age matched normal controls. what's most concerning, however, is that blue line that shows cortical thinning accelerates with age whereas the red line control group where it's almost completely flat and this suggests cortical thinning may indicate abnormal aging and risk for dementia that we can see right now in living individuals. next slide, please. now, this is a study that we did in germany with elite soccer players. we selected them specifically for not having a history of concussion and not having any symptoms whatsoever. what we found was compared to swimmers, professional swimmers, there was a huge difference between the two groups with the controls on the left and the sockers players on the right. almost a complete separation between the two groups with an increase in what's called radial

diffusivity, damage to the brain. next slide, please. what we don't know. why do concussive and subconcussive trauma result in some and not others. another question we don't know, why do some develop neurodegenerative disease and others do not. what are the predisposing factors. is exposure genetics involved. not every football player, not every soccer player, not every hockey player who plays and gets hit ends up with nerve degenerative diseases which i think people are most concerned with. next slide. so what we need is diagnosis to detect early. imaging tools sensitive, widely available and can be applied in vivo. prognosis to follow recovery and degenerative processes. we need to follow recovery and degenerative processes to predict who will have a poor out come and who will have a good

outcome. knowing that we might be able to intercede with treatment, possible cascade of neurodegenerative changes. finally, summary next slide sports concussion leads to onalteration of the brain's white and gray matter. detect alterations following concussions and subconcussive brain trauma and the impact over time is important. we need longitudinal studies to identify different stages of recovery and being able to pick out ahead of time what is going to lead to a poor outcome so we can intercede. finally some resch of safety such as returning to play, observable evidence of brain trauma. thank you. >> thank you. very impressive testimony from everyone. i was even impressed that you all stuck to the five minutes pretty close. now.

i'm going back to dr. molfese. i think your testimony and dr. shenton's kind of juxtapose nicely. part of your research is finding that baseline of the new athletes that enter university of nebraska. is this allowing you to detect the injuries earlier that there may have been some pre-existing subconcussion? how are you identifying that, what is it telling you, and what is the university doing to implement some level of protections? >> one of the major changes we've seen, and i think this is occurring across the field now, is the effort to get preconcussion data. so basically more schools are moving to assess student athletes prior to the start of the season.

then that certainly is what we're doing. should a player be injured and they are identified through trainers or the medical team, one of the weaknesses here is that the players do not always self-identify. so we've run across that a number of times in our testing. we'll pick up something on our test the trainers and medical team didn't know about simply because the player didn't disclose. then we also tried to test somebody else who plays a similar position but has not been injured and they act certificate as control over the season. what we're finding both effects that occur across the season in both our normal players with no history of concussion being identified their brain's speed of processing does change over the four to five months of training and the season. players who do experience a

concussion, we see in terms of brain electrical activity, again, this slowdown of about 200 minimlliseconds. four times faster than the slowdown in multiple sclerosis, for example, for a contrast. clearly the brain has changed the way it's processing. there's some data early alzheimer's working memory type tasks. even a week of intervention shows a four to five week gain, continual gain in improvements. so we're trying to see if we can see some of that occurring. >> thank you. dr. gay, in regard to concussions, many times it's not a direct below but coup contracoup, head going back and forth and brain sloshing around.

you mentioned going back to 1970s type of equipment. tom osborne likes to talk about the neck roll. describe to me by what you mean by 1970s equipment and how it might reduce concussions. >> the neck roll, what i call a horse collar, is really a piece of equipment that's dapd from the game. it does an important thing. it essentially immobilizes the head. so if concussions are incurred by ralging of the brain back and forth especially from a blow to the side, the horse collar will substantially damp that down. to my knowledge, there are no epidemiological studies of that being effective, but i can't -- my personal opinion, even though i'm ignorant -- largely ignorant of medical science, if you immobilize the head that's going to solve a lot of problems,

especially with these rotational hits. yeah. >> dr. graham, does that make sense? >> i think whether or not the horse collar would have that effect, i don't know. of course, our committee was based clearly on science and reviewing the literature. but i think the principle is you want to find ways to minimize the linear and rotational forces that come into effect with a blow to the head. whether you can do that by equipment, whether you can do that by change in play, that's what you have to do to decrease the evidence -- the incidence of concussion. >> thank you. i only have 11 seconds left so i'll yield back and recognize the ranking member miss

schakowsky. encouraging safer play for the risk of injuries. mr. heaton, you spoke about the need to change the -- i'm quoting from your testimony -- win at all cost attitude among players and coaches. what would you tell teens to help them change that attitude both within themselves and teammates and perhaps more challenging in coaches? >> thank you. well, frankly, i would actually encourage the coaches to stress this as much as possible as well as the parents. the coaches and the parents are there to help us learn how to play these sports correctly. if they can emphasize not having to worry about winning to the

point where you get hurt, it will trickle down to the players. the players become coaches. it's this never ending cycle of teaching and making sure that the players know that winning is not the most important thing. you know, it feels great to win. i'd much rather lose than have another concussion. >> clearly you were aware because of the severe consequences of the brain injury. do you think youth athletes understand what those symptoms are? >> yes. i think it's getting better, indeed, especially at my school. we emphasize making sure that you know the symptoms of concussions. i feel like it's spreading as well. >> let me ask dr. gioia that. >> education programs are directed towards the athletes.

quite honestly, about five years ago, maybe six years ago, there was a study that showed that was the number one reason why athletes weren't coming out of the game. they didn't know how to tie tomorrow symptomatology. it wasn't they didn't want to lose game time but didn't know themselves. athletes and teammates need to watch out for each other. the concussed athlete may not have the wherewithal to know they aren't right yet their teammate next to them does. there is a responsibility within that team to take care of each other. that's an important focus. >> that goes to culture as well. >> absolutely. >> dr. shenton, please explain a little how advanced neuroimaging works and describe the type of changes in the brain your lab is able to protect that traditional imaging can't and also some of the types of neuroimaging used by your lab have been a significant part of the research on diseases like alzheimer's and

schizophrenia. why are the same imaging techniques appropriate for research on these diseases and on sports related. >> i have a slide at the end of my slides that just explains in one slide diffusion imaging which i think would help out here. >> the one slide i really didn't under, was it comparing swimmers with -- >> with soccer players but i was going to go through and show you why diffuse injury is important. the injury that happens in the impact to the brain is generally a stretching of the cables in the brain, really the white matter. for example, the largest white matter track in the brain. you get shearing. this doesn't show up on tradition ct or mri. in fact, the first mild tbi conference i went to, no one showed a brain.

i looked to my colleague and said why would no one show a brain? because everyone knows you can't see anything on the brain. i said, but nobody is using the right tools here. this is just a very simple principles of diffusion imaging. if you look on the left, this is ink that goes on a kleenex. it goes in all directions. that's iso tropic. if you look on the right, an iri aniisotropic. this the principle used quantitatively to look at the brain. if you're in it's very round. it's iso tropic, everything goes matt same direction. if you're looking at white matter you're restriblted in two directions. you can measure what the integrity is of white matter fiber bundles in the brain. that's what you need to look at in mild tbi. if you have someone come in with a moderate or severe brain

injury, you don't need this kind of technology. they are just going to be put into neurosurgery and do an operation. it's these very subtle brain something like diffusion imaging. we have shown over and over again now that you can see and it's not just our group, starting in 2003 people started using diffusion imaging because it's the most sensitive tool that exists to look at the injury which is the major injury in tbi. what needs to be done now is to look at acute injury and see what predicts outcome. do acute injury at 72 hours, at 3 months, at 6 months, can we then predict knowing that what happens at 72 hours if you have -- we have one in our lab

trying to separate water that's outside the brain versus outside cells versus incells. if you can predict from 72 hours, then you can go back and say maybe we want to put in anti-inflammatory medications. we don't know enough right now. the only way to know is to do these longitudinal studies and follow over time using sophisticated imaging technology in my opinion. once you know, you can diagnose. once you diagnose -- >> this could be very promising not only for our athletes, but our returning veterans and applied eventually to schizophrenia or alzheimer's. >> i'm primarily schizophrenia resear research.

we have imaging that shows early on at the first episode of schizophrenia you see fluid around the brain that's free water. it's like the ice sew troep pick. you see it restricted to inside tissue. this was a brand new technique developed by a scholar in our lab. >> i'm going to have to say thank you. it's very promising. thank you. >> yes, thank you. gentlemen from new jersey is recognized. thank you, mr. chairman. dr. johnston, you stated that many ports related concussions still go undiagnosed and i would like to know why in your opinion that is the case and how can we improve that? the state laws and also the involvement of coaches and players and pta's, areas where we need to have improvement? >> thank you for the question.

i think i would echo what has been said by others on the panel. sorry. i would echo what's been said by others on the panel that i think a lot has to do with recognition. people are very good at recognizing when someone gets knocked out. but of course that's a small percentage of all concussions. as our understanding of all the various symptoms that can go with concussion have arisen. it becomes incumbent upon us to improve the quality of the education we give to our coaches, players, trainers. officials, about the symptoms of con suggestion. my sense is in general the culture all the coaches are believers. they're not purposely hiding kids and putting them back in knowing they have concussions. sometimes it's hard to recognize especially when young athletes

don't tell you how they're feeling and other issues were brought up with the importance of teammates being involved with diagnosing these players so they can be pulled and appropriately evaluated. >> how close are we to a better design for helmets? >> i think that we are at the very beginning. i think we have been using a standard not changed for 40 years designed for skull fractures that has served its purpose. i think many investigators around are working to improve the quality of the standards to include linear and rotation acceleration as well as other important aspects of impacts. just like the automotive industry did 30 years ago with safety ratings. the market can be relied upon for manufacturers to improve their helmet designs to improve their sales. i think standards are important part of the equation. >> thank you. in your testimony you discussed

the fact that there is a kn numerical system. you called it the best tool we have for analyzing the merits of various helmet systems. can you explain how the numerical scoring system works? >> yes. thank you. basically it involves a test where you drop the helmet from a given height, a varying height to the side, to the front, to the back. it tries to simulate the kinds of impacts that a football player would actually experience and numerical scores are given to the maximum acceleration that the head inside the helmet feels for these given drops based on a, in my opinion, fairly crude

initial model of what causes concussions. no effect taken into account of rotation, of temperature and in my opinion, the reproducibility is not as good as one would like having tried to do it, examples of these kinds of tests in groups that i have been involved with. so i think it's a good first start. it's the best we have right now, i think it needs to be paid attention to but there's a lot of room, a lot of room for improvement. >> thank you. and finally, ian, how old are you and what grade are you in? >> i'm 18 and i'm a senior. >> does that mean you'll be going off to college in the autumn? >> yes. >> do you know where you will be attending college. >> i'm going to elan university in north carolina. >> congratulations. and my condolences to you and your parents on the cost of higher education in this country. i have a god daughter who is a

freshman there. i'll be happy to introduce you to her. and let me say i am very proud of your testimony and i could not have done what you have just done when i was 17 or 18 and certainly i think the nation has benefitted by your outstanding testimony. >> thank you. >> thank you. >> gentleman from mississippi you are recognized for five minutes. >> thank you, mr. chairman and thank each of you for being here and sharing your expertise on what is a topic we're really just, i think, only really learning about as it's been in the news for several years but it is coming to the forefront in your work and your information and your testimony on the record here today. i think will be beneficial to us. as a parent of a 24-year-old

young man with fragilec syndrome i particularly love the things you do. i had some discussion with parents back home and the interesting discussion is i had several friends who have daughters playing youth soccer and a number have reported an increase in the number of concussions suffered by young ladies playing youth soccer. we seem to always associate it with nfl and helmet to helmet contact and concussions and things we see on the field but it appears in everything we do in life. every sporting event. there's that danger and that risk. that's why i think what you're doing with the alabama doctor johnson is the preventative part

of it. is how do we educate our players and coaches, parents. and perhaps, if using a teammate approach, it may be the safest thing may be to have the backup position player be the one to report for the first teamer when they need to come out. that might get them off the field. but thank each of you for your work. dr. johnston, what is a subconcussive impact? what does that mean and how important is that when addre addressing concussion diagnoses? and should sub concuconcussive s affect rules of game of play and if so, how? >> i think the definition would be all those other -- the 99.9% of impacts that happen that don't result in a concussion. as has been pointed out, that the rub with concussion is the diagnosis part. if you look at the historical

studies, rates of concussion in different sports, it's variable. and a lot has to do with who is diagnosing it. males versus females. whether or not men are more or less likely to report symptoms. i think it's all those other impacts that have found more and more information with the important imaging done in boston and other places that even the sub concuconcussive impacts hav results in terms of structural changes in the brain overtime. i think the subconcussive impact needs to be addressed in terms of lessening the overall load that the player has. football is the obvious thing in terms of player practices and how many practices a week children should be able to do. but i think that has applications for all sports. >> thank you. dr. mulfese, if i could ask. the 77% of military.

>> yes. >> that figure, is that how many of tbi cases have suffered concussions or is that 77% of all military? i wasn't quite sure. >> of chronic, 77% are concussions, mild tbi's. >> i got you. can you tell us more about the sideline imaging work that you're doing? is this practical? is this something we can expect to see rolled out to sidelines across america to diagnose for athletes and on to battle fields to diagnose our warriors? >> i think it's possible. we published a paper just this last year where we took one of our systems and recorded on the sideline of a field. the biggest challenge for us in making a practical is to get the processing time down. at this point takes us an hour. if we can get it down to five minutes, then i think we can

sell it to the coaches. they're the ones that are going to determine. and i guess at this point given all the other issues -- the common tests are the impact. which are tools, sort of questions to the player and they have to reflect and they may be foggy because of the concussion. but these tests don't have any predictability or reliability after two days post injury. that's our big problem. doesn't predict recovery time, severity of the injury and so on. so these buy you markers that we are talking about are the critical things that we're hoping are going to be much more reliable. >> thank you. >> thank you. generally this would end. but we all have so many questions. we're actually going to do a second round and plus the bells aren't going to go off for at least another seven minutes.

and jan does have a conflict and she has given us approval that she's going to leave but she trusts us to ask legitimate questions. >> but let me just really thank this panel, the previous panel as well, but the intensity of the scientific research and then the application to the playing field and actually so many other fields, i really want to thank you for telling us what's going on. and i also did want to thank ian for coming here today. i think it's important to have people like brianna and ian to tell their stories and give us a face to the importance of this. i want to thank the ftc, too, for making sure that false claims aren't made. but this is so important, so appreciated. and then we'll have to figure out where it leads us. but it certainly has informed us. thank you. >> i would agree with every word

of that. so this is a question to you, dr. mulfese and dr. shenten and it duck tails into what the gentleman from mississippi was talking about. are the symptoms of a concussion or tbi uniform enough so that it's possible for early detection or developing a checklist for a coach or a parent to be used, you know, but nonmedical? we'll start with you. >> no. >> well, that was easy. >> the symptoms overlap with depression and ptsd and that's been a problem. in fact there was a paper published in the new england journal of medicine that said when you remove the effects of depression and the effects of ptsd, mild tbi doesn't exist.

that's a real disservice. it used to be people would claim that when people came in complaining that they still had symptoms from hitting their heads, since there was no evidence from conventional mri or ct, they said go see a psychiatrist. so it was really not appropriate at all because there's at least a small minority of people who have mild concussion who go on to have symptoms, and they can go on for months, for years and then they can clear up. that's separate even from cte. what you need is radiological evidence for diagnosis the same way you would want to know values of a blood test for cholesterol or a broken leg. i think we're moving in that direction. that's what we need as the hard evidence because the symptoms are too nonspecific. >> doctor? >> there are a studies looking at the number of symptoms and a

wide variety of symptoms people report. there's no data that indicates whether somebody reports lots of symptoms versus a few, that that has any relation to how long they're going to recover, how serious it is, how great the impairment is unfortunately. >> can we get to a point where a 7th grade coach, a 7th grader taker as big hit, that there's a checklist per se, that the coach can use to determine if that kid should go back into the game? >> i think there are guidelines out that list concussion symptoms and so i think the general buy as at this point is if the individual reports any of the symptoms that they should be pulled. we know there is data to indicate if you do have a concussion and you start playing before the symptoms resolve, the likelihood of even death is much greater. not to mention further significant concussion that's going to take longer to recover.

>> all right. so this one is for dr. johnston and dr. gioia. one of the debates occurring in the state of nebraska right now is you have a child or a high school student that suffers a concussion during a game. so it's been diagnosed. what do you do next? right now the thought is you keep them home or her home, dark, no electronics. that's kind of the norm. there's a discussion whether that's appropriate or not. or to what length. what do you know? what would you recommend? >> well, i will tell you about how we handle things in alabama and i think a lot is based on the cdc guidelines which is once a athlete is diagnosed they're removed from the field of play and then evaluated. we use the scat, a sideline

based assessment and use it afterwards as well. it has a mini inventory of neurological exam and function. and when children have symptoms, they don't return to any activities until the symptoms have resolved. those children who have symptoms lasting beyond the two weeks are referred to psychologists. >> you recommend dr. gioia? >> yes. it comes to what's the best treatment for this injury. and let me just say the field is moving on this one. and the recommendations that we make and i have written several recent papers on this is that in that acute stage of symptoms, probably the first few days, maybe for some, little bit longer if there's more severe number of symptoms, is that they really reduce they're activity.

but what you want to be doing is increase the activity over time. we don't black box kids until they're asymptomatic. that has likely negative effects on kids being removed. what we do is initially shut them down, restrict them and gradually start to bring them back to school and physical activity. but that has to be individualized based on the severity of the symptom presentation. that's where we are right now. we need a whole lot of research to help validate that. >> thank you. mr. lance? gentleman from missouri gets to ask another question. mississippi. i thought you were billy long. >> that hurt. that hurt. thank you, mr. chairman. and a couple of questions that i would have. one would be if we're looking at

this -- doctor, if the i may ask a question? >> yes, sir. >> in your testimony you state that football players at the elite levels are shedding equipment to increase speed and mobility. >> yes. >> but the decision of which helmet to where is their own and that player often chooses a helmet's looks, shape, feel, over its collision cushioning ability or safety features. do some physicians require different levels of cushioning? would you recommend a specific helmet? >> that's a great question. currently there are no position specific helmets being made. i think the helmet manufacturers try to do the best they can for everybody. i would say that not to belabor the point but i think for a lineman where you typically get no severe hits but a lot of subconcussive blows, that horse

collar is crucial. i wouldn't recommend that a whiteout wear a horse collar. that would affect the quality of the play. it's an interesting point because certainly some players might tend -- this is why i'm an advocate for the hits system. it will give us much more detailed information about what positions get hit where. one could envisionen if we have a large database then improving helmet design to react to the information that we got from that kind of information. >> dr. graham, if i could ask you, how much money has been september on sports concussion research and where is most of the funding coming for for that research? >> unfortunately that was not an issue that our committee looked at nor would we have the resources to pull it out.

clearly you can identify some research being done in the federal sector that applies to this. but the private research that may be done by the sports, the manufacturers of equipment themselves, i don't know any good way to quantify that for you. >> i appreciate everybody being here. it's a very important issue. we love our children going through sports. we love to watch it. and we don't want anybody being hurt that shouldn't be hurt. so hopefully this increased focus will lead to better research, better safety equipment, detection and of course, prevention. so thank you so much. i yield back. >> thank you. the gentleman from mississippi. and i just want to thank. this was a truly all-star panel of medical experts and physics. and much appreciated. ian, thank you. and so that does conclude our

hearing for today. now, for our witnesses. we, whether we showed up or not, have the right to send you a question. it's called a written question. we have about 14 days to write those and submit them to you and i would appreciate a couple of weeks. you don't have to do it right away. but at least if you can get them back to us, if there are any, within about 14 days. i just again want to thank you for coming out and providing some very, very valuable testimony for us. and we are adjourned. >> announcer: tonight business owners discuss the problems in the future of the legal cannabis industry. this was part of a receipt event in denver characterized by organizers as the first summit

of it's kind. recreational marijuana has been legal for about 18 months. here's a preview of tonight's event. >> money is one of these things that really kind of can gal vannize people. if you're here, you're mainly for money, that's great. and i think that a lot of people come to this industry because of the opportunity, the economic opportunity but that's not what keeps them. what keeps them are the people the passion, the change that we're making. the pioneering spirit that we're building. and because, you know, this is different. your businesses aren't like other businesses. so i think it's going to be an interesting ride as we look at our different motivations for

being involved in this sector. and we learned this, that if you want something done in this world, you've got to figure out how to make it profitable. i was going to say that the hippies keep being right, right? they were right about renewable energy, organic foods. right about cannabis. look at renewable energy and organic foods. these are movements that started because people cared about something. they cared about the environment. they wanted to use renewables. they cared about the health of the farms and the land and about what we put in our bodies. it started out really small and with an activist sort of flavor but once they figured out how to have profitable business models around those ideas, boom!

now organic foods are everywhere. renewable energy is growing by leaps and leaps and bounds. and i think that's what the cannabis industry is doing for freedom. >> see that discussion on cannabis tonight beginning at 8:00 eastern on cspan. and american history tv marks the history of lindon johnson's civil rights integration act. beginning at 8:00 president johnson signing the civil rights act into law. also a recent congressional ceremony commemorating the 50th anniversary and a couple events. american history and prime time airs all this week beginning at 8:00 p.m. eastern on cspan 3. earlier this week the supreme court handed down a decision

including a decision on contraceptives coverage. they're out of session until october. on facebook and twitter we have been asking you about your opinion of the supreme court. jane writing i'm okay with them as long as they don't become activist judges. our co our constitution is the law of the land. and karen says, politically motivated, short sided and disappointi disappointing. weigh in at twitter using the #cspanchat. >> remind your children in this buy centennial year when we are the first generation of americans to have experienced the tax on the continental united states. we were the first generation of americans to feel like what it's like to have your government

attacked. remind that our countries greatness is found in one another. that's what the star spangled banner is about and this commemoration year is about. to lift every voice and to sing. >> a three day 4th of july weekend starts friday on american history tv. friday at 8:30 p.m. eastern. saturday night at 8:00 visit the classroom of professor joel howl as he talked about radiation experiments conducted after world war ii. and sunday jeffrey engles man knew script of george w. bush. >> homeland security secretary jay johnson testified on capitol hill on the influx on uncompanied children coming across the u.s./mexico border. he was along with fema

administrator and u.s. border patrol deputy chief. during the hearing house republicans said the obama administration immigration policies contributed to the problem and urged the national guard be sent to the southwest border. since october more than 52,000 immigrants have been apprehended by customs and border protection. >> the committee on homeland security will come to order. the committee's meeting today to examine the current crisis at the border regarding uncompanied children. i recognize myself for an opening statement. today on the southwest border we are facing an escalating ref gee crisis. parents are handing over their children to cartels smuggling

these kids to the united states. many are under the age of 10 including some barely old enough to walk. these children with no parents, relatives or legal guardians risk a periless and fatal journey. as a father of five, it's unimaginable to me that what would compel a parent to risk the lives of their children on such a dangerous passage, not to mention the risk of sexual assault, exploitations and the potential to be trafficking. when they arrive at the border, the children are simply turning themselves into the nearest border patrol agent. however, patrol stations are not set up to handle this massive and growing number of detainees let alone children. shelters have been established like the one at the air force base in san antonio.

we have seen the foetphotos of hundreds of children piled on top of each other and the flow shows no signs of evading. every member of this committee including myself is gravely concerned about the safety of children no matter where they come from. since october, 52,000, 52,000 unaccompanied mi unaccompanied minors have crossed. nearly 2/3 crossed from the grand valley in texas. cvp estimates next year more than 150,000 unaccompanied children may attempt to cross our borders. this is a crisis. it's a crisis that's been in the making for years. one that we should have seen coming. a few concrete actions have been taken. the department of homeland security and the united states government as a whole has been slow to act turning a blind eye to the warning signs. the tragic fact is the children

are making a dangerous journey based on misinformation and the false promise of amnesty. the first step is for the administration to acknowledge a cause of this problem. no one questions the fact that there are horrible economic conditions but these conditions are not new. what is new is a series of executive actions by the administration to grant immigration benefits to children outside the per view of the law. the relaxed enforcement posture along with talk of comprehensive immigration reform. it is beyond dispute that such a behavior encourages people to come to our country illegally. in fact, newspapers in el salvador and honduras seem to be encouraging youth to head to united states based on these policies. and recent internal dha surveys

of the children reveal that more than 70% believe they are going to stay in the country. this administration should send an unambiguous message that those arriving will be promptly sent home. i for one do not want to see another child harmed because we have not clearly articulated the realities on the ground consistent with current law. yesterday i was glad to see secretary johnson's letter, an open letter to the participaent children notifying them there are no free passes into the united states. this is a good start. a lot more needs to be done. in addition to a robust and effective public service campai campaign, we should engage with the government of mexico to step up their efforts to secure their southern border. i call on the president of mexico and his interior minister

to do just that. i'm very concerned that this recent surge is weakening our border security efforts here at home. border patrol agents and officers are being taken away from their main duty. their mission for tracking down drug and weapon smugglers as well as criminal aliens. operation control of the rio grand valley may be suffering. cartels will exploit this situation. the state of texas said it would surge security operations. in order to fill the void. states should not need to protect what is in the federal government's rule under our constitution. the president needs to immediately send the national guard to the southwest border to deal with this crisis. we need to find solutions to this crisis.

and soon. and while secretary johnson has largely inherited the current situation, i look forward to hearing now how he is planning to respond to this emergency. again i want to thank the witnesses for being here today on such short notice. the chair recognizes the ranking member. >> thank you, mr. chairman. i want to thank you also for holding today's hearing. i want to thank the witnesses also for their testimony. on a daily basis children ranging from toddlers to teenagers are fleeing violence, sue press and economic desperation, many of them sent by their families. they are simply looking for a safe haven. as an humanitarian crisis develop. >> we're finding its origins to be complex as its implication. it is irresponsible to attribute

this crisis to one u.s. policy or for that matter, one u.s. president. despite by many, this crisis is not just an immigration matter nor is it just a foreign policy matter. this crisis is not exclusive to the united states. much of the western hemisphere is reeling with this crisis. according to the united nations these children are streaming into mexico, panama as well as canada and the united states. from our perspective, we seem to be baraged on a daily basis by troubling imaging of children crossing the border into the united states and being immediately apprehended by border patrol officers. officers have detained children at the southwestern border.

the number of kids arriving at our border seems to grow by the day. the influx of these kids has strained border patrol resources. in 2008 president george bush signed the william trafficking victims authorization act. the law recognizes that special care is demanded when dealing with the young and vulnerable. under the lawyers the border patrol is required to take unaccompanied children into custody. screen them and transfer them to the department of health and human services office. i would note for the record that during this challenging time even though border patrol has had to ramp up activities in the rio grand valley, the agency's effectiveness rate as improved. for those out there looking for

simple answers to lay the blame on president obama's policy, on the action for childhood arrivals or even the senate comprehensive immigration reform legislation, i would note neither would apply to these kids. hence, the assertion that the recent surge of children is due to lax immigration enforcement does not pass the smell test. in a time of crisis such as this, we need to get our priorities in line and find both near term and long term ways to address this situation. on june 2nd the president tapped secretary johnson to establish a quarter meeting group to ensure federal unity of effort to address this situation. in turn, secretary johnson appointed fema administrator to be the federal coordinating official and lead those efforts throughout the executive branch. looking out to the long term, we need to do more to turn the tied

on this crisis but among other things, the greatest ability among our neighbors and dissuading families from taking such action. over the weekend secretary johnson issued a public service announcement and various central american countries debunking the myths about the policy and informing the parents about the danger of traveling from central america to the united states. today i want to hear from the department about the response and their work with other fellow agencies including the departments of health and human services, defense and state in addressing this crisis. we need to organize all our federal agencies involved to effectively address the sudden surge. looking beyond dhs, there are questions to ask about hhs's resources for that matter. state's engagement through

security initiatives such as e the -- i recognize that the panel assembled today may not be in a position to answer this question but it is a question i will be pursuing. dehumanizing and labeling these kids and parents will not yield the solution. labeling this as an administration failure will not address what is actually going on in el salvador, honduras that would cause a parent to hand over their son or daughter to a smuggler or send their child to the united states. at this time we can use our platforms to rise to the occasion and be helpful. or we can engage in political grandstanding at the perile of young lives.

it is my hope this committee can choose and be a model for effective leadership on this matter. with that, i yield back. >> i thank the member for his constructive comments. other members are reminded opening statements may be submitted for the record. we're pleased to have a distinguished panel. first johnson, sworn in as a secretary of the department of homeland security. prior to joining dhs he served as general counsel for the department of defense, led more than 10,000 military across the department. as general counsel, secretary johnson oversaw the development of the legal aspects of many of the nation's counter terrorism policies and spear headed reforms to the military

commission systems at guantanamo bay. and you have see this crisis firsthand. we thank you for doing that. he is accompanied today this morning by mr. greg, the administrator and the deputy chief of the united states border patrol. mr. fugate and mr. videle are here to answer any questions anybody may have. the secretary submitted a written statement on behalf of the witnesses appearing in the record. the chair now recognizes the secretary for five minutes for his opening statement. >> thank you, chairman. you have my prepared statement. i will deliver an abrief yated version of it. members of this committee, thank you for the opportunity to testify today about our efforts to address the recent rise of

unaccompanied children and others crossing our border. with me today to answer questions are craig, the ad main administrator of fema and deputy cheap ron butello of the u.s. border patrol. we face an urgent situation in the rio grand valley. last fiscal year, we app rended more than 20,000 unaccompanied children. that number has doubled to more than 52,000. those from el salvador, honduras make up 3/4 of that my great lakes. on friday i traveled to south texas this time to lead an interagency team to oversee our efforts. while there we met with officials to review the situation and hear directly from those on the ground what their

needs are. while there, i spent time talking with the children again. it is a vivid reminder that this is a humanitarian issue as much as it is a matter of border security. we're talking about large numbers of children. without their parents who have arrived at our border. hungry, thirsty, exhausted, scared and vulnerable. how we treat the children in particular is a reflection of our laws and our values. therefore, to address this situation our strategy is three-fold. first, process the increased tied of unaccompanied children through the system as quickly as possible. two, stem the increased tied of illegal migration into the rio grand valley. and three, do these things in a manner consistent with our laws and values as americans. so here's what we're doing. first, on may 12th i declared a level of condition readiness

within dhs which is a determination that the full capacity of cbp to deal with the situation is full and we need to draw upon additional resources across all of dhs. i appointed deputy chief to my left to coordinate this effort within department hs. second june 1st president obama consistent with the homeland security act directed me to establish a coordination group to bring to bare the assets. this group includes dhs and all of its components. the department of health and human services, defense, justice, state and gsi. i in turn have to my right to serve as the coordinating official for the u.s. government wide response. third, we have established added capacity to deal with the processing and the housing of the children. we are creating additional

capacity in places and considering others. fourth, dhs and hhs are increasing spanish speaking case management staff, increasing staff handling incoming calls from parents or guardians. raising awareness of the parent hot line provided by fema and operated by hhs. surging staff to manage the intake of cbp referrals to track shelter bed capacity and facilitate shelter designations. here i must note from personal observation that our border patrol and other personal as well as perm from hhs, ice. fema and the coast guard are doing a remarkable job in difficult circumstances. all of these dedicated men and women deserve our recognition, support and gratitude. fifth, dhs is building additional detention capability for adults crossing the border illegally with their children.

for this purpose dhs is establishing a temporary facility for adults and children on the federal law enforcement training center ears campus. the establishment of this facility will help them process those across the border and allow to increase the capacity to house adults and children in a manner that complies with federal law. departme dhs is considering to increase the capacity and increasing number of adults with children illegal crossing the southwest border. sixth, dhs has brought on more transportation to assess in the effort. helping transport the children. leasing additional charter aircraft. seventh, we are conducting public health screening for

those who come into our facilities for any symptoms of contagious diseases or public health concerns. both dhs and hhs are ensuring that the children's nutritional and high jennic needs are met while in custody. children are provided regular meals and access to drinks and snacks throughout the day, they receive constant supervision and children who exhibit signs of illness are given proper medical care. we made clear that all individuals will be treated with dignity and respect and any instances of mistreatment reported to us will be investigated. eighth, working through fema's national response coordination center, we are coordinating with voluntary organizations to help us manage the influx of unaccompanied children crossing the border. the american red cross providing blankets and other supplies and is coordinating calls between

children in the care of dhs and families anxious about their well-being. 9th, to stem the tied, we have also be in contact with senior government officials of el salvador, honduras and mexico to address the interests. promoting the max exodus and how we can work together to insure faster secure removal. last week president obama spoke with mexican president about the situation as has secretary kerry. this past friday vice president biden visited to meet with regle leaders to address the influx of children from central america and the underlying security and economic issues causing this my great lakes. the vice president announced the u.s. will be providing a range of new assistants to the region

including additional funding for central american governments to receive and reintegrate their citizen and a new u.s. agency for international development program. over five years to improve citizen security. and additional 161.5 million will be provided this year to the central american regional security initiative to enable american countries to respond to the nation's most pressing security and government's challenges. i will travel to gat mall la on july 8, 9. the govern of el salvador has sent to expedite. adding personnel and resources to the investigation, prosecution and dismantling of the smuggling organizations

facilitating border crossings. 11th, we are intensifying our public affairs campaigns. in spanish, with radio, print and tv post to communicate the dangerous of sending uncompanied children on the long journey from central america to the united states and the dangers of putting children into the hands of smuggling organizations. as the chairman noted i have issued an open latetter to the parents sending those children which has been distributed broadly in spanish and english to highlight the dangers of the jourp any and to emphasize there are no free passes at the other end. we are stressing the deferred action of childhood arrivals does not apply to children arriving now or in the future in the united states and that to be considered for, individuals must

have continually resided in the united states since june 2007, seven years ago. we're making clear that the earned path to citizenship contemplated by the senate bill passed last year will not apply to individuals crossed the border now or in the future. only to those that have been in this country for the last year and a half. 12th, given the influx of unaccompanied children we have increased staffing and detailed 115 additional experienced agents from less active sectors to augment operations there. i'm considering sending 150 more border patrol agents based on my review of operations there this past week. 13th, in early may i directed the development of a southern border and approaches campaign effort putting together a strategic framework to further enhance security for our southern border. finally, we will continue to

work closely with congress on this problem and keep you informed. dhs is updating members and staff on the situation in conference calls twice a week and we're facilitating site visits to texas and arizona for a number of meshes and their staff. i have directed my staff to be forth right in bringing to me everything in consideration to address this problem. in cooperation of the agencies of or government dedicating resources to the effort with the support of congress and cooperati cooperation, i believe we will stem this tied. thank you. >> thank you. the chair recognizes himself for questions. let me say first i commend you for your immediate response to this crisis. but we do have a crisis on the border. it's in our backyard and

impacting my state, particularly, probably the greatest. when i see our military base is now turning into refugee camps in the united states i think that's something i thought we would never see in the united states. i talked with the senior officials down the rio grand valley sector. we have 250 -- over 250 children being apprehended every day down there. and i think the saddest thing is the exploitation of these children. as you mentioned in your open letter, you said it's dangerous to send a child on a long journey from central america to the united states in the hands of smugglers. many children are traumatized. psychologically abused or worse beaten. sexually assaulted or sold. they're exposed to psychological

abuse at the hands of the criminals. we see these publications down in central america saying if you come into the united states, you can stay. now whether that's a misinterpretation of our policies, i think there's a lot of confusion out there. i personally believe that this administration's policies have contributed to this problem and have encouraged more people to come. when i talked to law enforcement, whether it's border sheriffs, they believe that this problem will continue until we provide a deterrence, a strong message that if you do come, you cannot stay. and so secretary johnson, what are you doing in that respect? what deterrence are we providing to stop this? if we don't provide that deterrence, this problem will not stop. >> i agree. first of all, we need to stem

the tide. these gentlemen here to my left and right are leading an effort to deal with the current capacity but we have got to stem the tide. i believe among the things i listed here as what is critical is we correct the record. we straighten the misperceptions. the smuggling organizations are creating a misinformation campaign that there's a free pass. i even heard that you have to get here by may 2014 in order to get your free pass. the smuggling organizations have an incentive to induce these kids to have their families pay money to smuggle them up here. they're putting out misinformation which we're trying to correct through our public awareness campaign. but we're also building as i mentioned, increased detention capability for adults who bring their kids into the country to expedite their removal and

return back to their home nations. the other thing that we in the department of justice are very focused on right now is going after the networks of smuggling organizations through their financial transactions, through prosecuting the personnel. we surged doj and criminal investigators for that purpose. we have need to stem the tide. >> i think that -- i know in 2006 we had a brazilian crisis and provided mandatory detention and it worked. i think the administration needs to look at that. i think the national guard -- i know dod doesn't like that option. if they could help with the influx and allow border patrol to do their job on the border, i think that would be helpful as well. in the limited time i have i want to focus on what i think could be a very good solution to this problem in addition to deterrence. you and i talked about this issue. it has to do with mexico. and mexico's cooperation with

the united states. they are allowing this to happen in their country. the drug cartels are exploiting the children. we know that the mexicans southern border is completely wide open. i know that we have offered assistance to mexico that to date i don't know whether that has been accepted but my information is that it is not -- has not been. i would like to commit my efforts to work with you to get that problem solved because i think as you look at these children, they're all coming from central america. if we can close the southern border of mexico, that stops 99% of our problems here. mr. secretary, if you wouldn't mind commenting on that issue. >> first, as i mentioned in my owning comment, i want to hear every legally available option, whether it's from my own staff or inner agency or members of congress or former government

officials. i want to hear every available option. clearly, the key -- a key to this is what the government of mexico can do. i agree with your assessment. as you and i have discussed in private. we need to engage that government at the senior most levels and we have begun that in president to president discussions. and i have had discussions with my counterpart. i think that mexican -- the mexican southern border are shared border security interest is the key. i also think that engagement with the government of good muaa is the key which is why i'm going there next month. >> i think you're right. the state department has a role to deal with central america in this crisis.

with that, recognizing the ranking number. >> thank you, mr. secretary for your excellent testimony. how often have you had a discussion with or burwell on this situation? what i'm looking for is, right now the microscope's on you. but there are some other players in this effort also. are you having discussions with -- with other officials of the cabinet? >> yeah. oh, yes, definitely. on june 1st, as i noted, the president established a -- a government-wide effort pursuant to the homeland security act to deal with this and set up a unified coordination group, which i oversee. administrator fugate is in charge of it, which brings to bear the resources and assets of

not only dhs, but hhs, doj, department of defense. and so we have an effort which fema, day to day, craig and his staff day to day coordinate and support. in addition to that, we're in routine -- i'm in routine conversation with my cabinet counterparts about this issue. i'm having a meeting with my cabinet counterparts right after this testimony, as a matter of fact. last friday i brought a group of interagency colleagues down to mcgowan and langley myself. not langley. lackland myself to see the situation. so we're in good consultation with all these other agencies. >> yeah. just trying to make sure that there's an understanding that it's not just jeh johnson who's responsible for this issue. but there are other players also who actually we need to have

conversation with. one of the conversations that i think would be important is under existing law, how long would the children be in custody of dhs before they're passed off to hhs? >> under existing law, we are required to transfer the child within 72 hours to hhs. from the point at which we identify the child as an unaccompanied minor. i know that the provision in the law says there's an exception for extraordinary circumstances. but in general the legal requirement is 72 hours. >> and i guess my question to administrator fugate is, have you been able to coordinate the resources so that 72 hour pass on is working? >> at this time, with the number of children coming in, we're not meeting the 72 hours. but since june 1st, we've added over 3,000 beds to the health and human services office of

refugee resettlement. including the three military bases that previously were referenced. in addition to that, we wanted to get these kids as quickly as we could from the detention facilities to a bed, even if we could not get them to hhs's custody. so custom and border protection has built out one processing center. another one is coming online in mid-july. so at this point, we have not reached the 72 hours. but we're building more capacity to get children in beds. but also health and human services is stepping up placement for the longer-term care of these children. our other hope is, is that the quicker we can place children long term, either reunited with legal guardians or parents or with foster families while they await further proceedings, the fewer beds that will be required. we have increased capacity. but the number of children coming in have increased as well. and we have not reached the 72-hour mark.

>> and i guess the follow-up to that is, in your coordinating role, do you feel that the resources necessary to be successful have been made available to you? >> yes, sir. the challenges again in building out facilities and bringing on additional foster care facilities, these are licensed facilities. it is diligent work by a lot of federal agencies to get this work, and it is time consuming. that's why we looked at some intermediate steps to increase bed capacity within custom and border protection. but you do have, i believe, additional requests that have been identified from omb that there will be additional resources required in the next year. we continue to work within our authorities and within the budgets we currently have. >> mr. vitiello, can you tell us whether or not the border patrol

as it's presently staffed can meet this influx of young people coming across the border? >> as is typical, the men and the women of the border patrol have stepped up to this task. i think you heard the secretary describe that we were there on friday. we watched the hard, diligent, heroic work they are doing to make the best of the situation. it's our -- it's my assessment and what we heard from the leadership on the ground down there, the agents that are involved in this crisis, we are adequately staffed and even better staffed than we were this time last year. so we are concerned as this goes on about staffing levels and our ability to do the other patrol border functions. but the reports that we got on friday, i'm very comfortable that they have the resources that are available and they're using them in an adequate way to protect the border. this isn't a security problem in the sense that this population, both the family units and the

children, are not trying to evade apprehension at the border. they're essentially coming in an area that's -- that's well known by us, well patrolled by us. they're not evading arrest. and the other locations along the border were adequately or -- we are better staffed or the same staffing that we had last year. so there is some risk involved here, but the reports that we heard on friday don't concern me. >> thank you. i yield back. >> chairman recognizes gentleman from new york, mr. king. >> thank you, mr. chairman. secretary johnson, let me thank you for your testimony today. before we get into this issue thank you for what you've done as far as counterterrorism efforts. i want to personally thank you for that. it's greatly appreciated. on this issue, let me get to the question that the chairman is raising regarding deterrence.

in your statement you say that you want to emphasize there are no free passes. i understand what you mean by that, but if you're parents in central america, in effect this can look like a free pass. you're making the situation more humanitarian. you're making more facilities available. as mr. fugate said, you're providing support to families. all which is understandable. that's our obligation as human beings. on the other hand, if you're a family in guatemala or el salvador this in a way is a free pass. it's a better life than they're getting in south america. i don't understand how that's going to restore what's happening. and on the issue of diplomatic engagements, it would appear that as the chairman said the southern border of mexico is the key here. do we have any realistic hope that mexico is going to be cooperative on that?

also you mentioned going after the coyotes? what's the time frame on that? as a practical matter we've been trying to do that for years. is there any reason to think the homeland security or doj can expedite that or be more effective? i'm not reflecting on you. i'm just saying we've been doing this for as long as i can remember, going after the coyotes. they're still there. i guess what is the deterrence? because the more you take what is proper humanitarian action, the more you're making it, to me, more accessible and more hospitable, and it seems to be almost a catch-22. unless we can step up diplomatic efforts regarding the southern border of mexico. and going after the coyotes. >> well, a couple of things. first, i'm convinced that the principal reason these kids -- from everything i've heard, everything i've seen, and from my own conversations with these kids, the principal reason they're leaving is the push factor from the countries

they're living. the conditions in honduras, for example, are horrible. it's the murder capital of the world. there is -- there is this misinformation out there that there is a permisos. that's what we're hearing. free pass. you get a piece of paper that says, welcome to the united states. you're free. that's not the case. when you're apprehended at the border, irregardless of age, you're a priority for removal. they're giving a notice to appear in a deportation proceeding. the way the law works, the 2008 law, we are required to give that child to hhs. and hhs is required to act in the best interest of the child, which most often means placing that child with a parent who is here in the united states. but there is a pending deportation proceeding against the child. now, in terms of -- but that's not a free pass. in terms of -- >> but if i were a parent in guatemala, wouldn't i see that as being a free pass? a 5-year-old child getting an order to show up in immigration court, are you going to actually deport that child?

to me, it is a free pass. from their perspective. >> congressman, i don't see it as a free pass, particularly given the danger of migrating over 1,000 miles through mexico into the united states. especially now in the months of july and august that we're facing. a lot of these kids stow away on top of freight trains. which is exceedingly dangerous. i spoke to one kid who was about 12 or 13 who spent days, climbed on top of a freight train. a boxcar. and these kids, sometimes they fall off because they fall asleep. they can't hold on any longer. it's exceedingly dangerous. >> i'm not saying it is a free pass. i'm saying how do we change their minds, not think it's a free pass, considering the poverty we're under. also if i could ask you on that, is the situation any worse in honduras today than it was two years ago or three years ago? any tougher economically or gangwise in these countries than